Helvetica chirurgica acta
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Helvetica chirurgica acta · May 1992
[Emergency surgery of a case of perforated gastroduodenal ulcer].
Surgical treatment of acute perforated gastric and duodenal ulcer is connected to high postoperative lethality. By emergency procedure it has to be decided between performing a simple closure or performing initially a definitive operation to control the peptic disease. The therapeutic options at our institution are based on a severity score which includes patient's age, associated pathology, grade of the peritonitis, delay between the onset of symptom and surgery, history of ulcer disease. ⋯ Based on our scoring system, 87.9% of all the patients underwent definitive operation. The lethality rate of this series of nonselected patients (52% were older than 70 years) was low: 6.3%. The use of the severity score help to choose patients to be treated by simple closure and patients which may be submitted to definitive emergency operation with low operative risk.
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Helvetica chirurgica acta · May 1992
[Breast cancer: locoregional recurrence and subsequent disease course].
The survival of 409 patients with breast cancer treated by surgery +/- adjuvant therapy is controlled in a retrospective study. 65 (15.9%) patients subsequently suffered from loco-regional recurrences. 41 (63.1%) of these patients showed either simultaneously with the loco-regional recurrence or at the latest within 2 1/2 years after the diagnosis of the loco-regional recurrence distant metastasis. The incidence of the distant metastasis is the more probable the shorter the interval between the primary treatment and the occurrence of the loco-regional recurrence. More prognostic factors for the survival after the diagnosis of the loco-regional recurrence are discussed.
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Helvetica chirurgica acta · Mar 1992
[Who should be hospitalized following mild craniocerebral trauma?].
The frequency of minor closed head injuries is high. These injuries may be complicated by the development of life-threatening intracranial hematomas. A well-defined selection criteria for admission must be proposed to guarantee an efficacious observation. ⋯ Following these criteria no intracranial hematoma would be missed in our patients with a GCS of 15. We suggest that the use of plain x-rays to identify skull fractures and subsequent hospitalization prevents missing an intracranial hematoma. Those patients with diminished levels of consciousness of focal neurologic deficits require admission irrespective of skull fractures.
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Pyogenic splenic abscess is a rare condition that tends to occur in patients with underlying often infectious diseases. The sensitivity of ultrasonography and computerized tomography has improve early diagnosis and follow-up. In our hands, splenectomy remains the therapy of choice, but we report the resolution of two uncomplicated splenic abscesses with antibiotics alone.
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Helvetica chirurgica acta · Mar 1992
Randomized Controlled Trial Clinical Trial[Effect of continuous postoperative analgesia with peridural bupivacaine on intestinal motility following colorectal resection].
In a prospective randomized trial the effects of continuous peridural analgesia on gastrointestinal motility and the postoperative course was studied in 48 consecutive patients with elective colorectal resections. 24 patients had peridural analgesia (PDA) with bupivacaine while 24 patients received intravenous analgesia (IVA) with pentazocine. With PDA the first passage of flatus and faeces was significantly accelerated. PDA was not associated with an increased rate of anastomotic breakdown and there were no respiratory complications in the PDA group.